Reviewer: Mary Kara Bucci, MD
University of Pennsylvania Cancer Center
Last Modified: December 9, 2001
Presenter: David G. Maloney
Presenter's Affiliation: Fred Hutchinson Cancer Research Center, Seatle, WA
Type of Session: Plenary
Myeloablative allogeneic hematopoietic stem cell transplantation (HSCT) for Multiple Myeloma has been associated with high transplant-related mortality (TRM), limiting its clinical usefulness despite its potential for cure. Autologous HSC rescue has a lower rated of TRM but does not have the curative potention of the graft-vs-tumor effect of the allograft. In order to combine the curative potential of allogeneic HSCT with the safety of autologous HSC rescue, this study followed a myeloablative autolgous HSCT with immunosuppression and an allogeneic HSC rescue, separating the high-dose conditioning regimen from the graft-vs-tumor inducing allograft by 40-120 days.
Materials and Methods
42 patients with relapsed or refractory Stage II/III myeloma received 200mg/m2 of melphalan and autologous SCR, followed 40-120 days later with a single fraction of 200 cGy total body irradiation, immunosuppression with mycophenylate mofetil x 28 days and cyclosporine at least 56 days and unmodified allogeneic stem cell transplant with peripheral blood stem cells from an HLA-identical sibling. The initial 4 patients received allografts of CD 34+ cells only; after the death of 1 patient from cytomegalovirus pneumonia, allografts were modified to CD34+ cells(8.6 x 106) and CD3+ cells (4.2 x 108).
This novel combined approach to stem cell transplant may offer a safer, potentially curative treatment option for multiple myeloma patients. Older patients, who traditionally have not been offered allogeneic transplant for multiple myeloma due to their increased risk of treatment-related morbidity and mortality may be suitable candidates for this regimen.
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